Eliciting Change Talk Notes What do you remember about change talk? What is it? 1. talk: patient language that moves towards the desired change in behavior. 2. talk: patient language that supports the status quo or moves away from change. 3. Expression of ambivalence (both change and sustain talk) is a normal part of change. Expressing ambivalence is NOT seen as resistance to change. But-in-the-middle vs. Yes-but s 4. The more talk by the patient that makes the case for change, the more/less likely the patient is to change. 5. The more talk by the coach that makes the case for change, the more/less likely the patient is to change. 6. If you are arguing for the change, and the patient against it, you ve got it exactly! Focus on Patient Language. Why change talk? GUIDE the conversation and provide opportunities for the patient to: Talk themselves into. Give all of the reasons why change would be beneficial. Express their motivation and desire to change (or be healthy). Come up with their own solutions and plans. Set goals for themselves and make a commitment. Focus on Patient Language. How to elicit change talk? The coach influences how the patient talks/ patient language by choosing: What type of questions to ask. What/how to reflect. When to ask for elaboration. When to ignore or redirect the focus. ICCC/CHCTO Weekly Teleconference Calls Page 1 of 6 Eliciting Change Talk
Build up the DARNs D for change: I want to quit smoking, but A to change: I know I need to quit smoking, but haven t been able to do it. R to change: It will help me to breathe better N to change: I have to, my health is failing. Eliciting Change Talk A Dozen Ideas/Strategies 1. Ask evocative questions (open ended and powerful) Why would you want to make this change? (Desire) How might you go about it, in order to succeed? (Ability) What are the three best reasons for you to do it? (Reasons) How important is it for you to make this change? (Need) So what do you think you ll do? (Commitment) 2. Ask for Elaboration When a change talk theme emerges, ask for more detail: In what ways? How do you see this happening? What have you changed in the past that you can relate to this issue? 3. Ask for Examples When a change talk theme emerges, ask for specific examples. When was the last time that happened? Describe a specific example of when this happens. What else? 4. Query extremes Ask about the best and worst case scenarios to elicit additional information: What are the worst things that might happen if you don't make this change? What are the best things that might happen if you do make this change? ICCC/CHCTO Weekly Teleconference Calls Page 2 of 6 Eliciting Change Talk
5. Look forward Ask about how the future is viewed: What may happen if things continue as they are (status quo)? If you were 100% successful in making the changes you want, what would be different? How would you like your life to be in the future? 6. Look back Ask about a time before the current concern emerged: How have things been better in the past? What past events can you recall when things were different? 7. Come alongside Explicitly side with the negative (status quo) side of ambivalence. Perhaps is so important to you that you won't give it up, no matter what the cost. It may not be the main area that you need to focus on in our work together. 8. Consult thyself Let s say that you were listening to a good friend of yours who was facing this same dilemma, what advice might you have for her/him? 9. Let s pretend/hypothetical Change Great in contemplation phase Encourages curiosity without risk Suppose or Let s pretend 10. Explore goals and values Ask what the person's guiding values are. What is the most important life value? Using a values card sort can be helpful here. If there is a "problem" behavior, ask how that behavior fits in with the person's goals or values. Does it help realize a goal or value, interfere with it, or is it irrelevant? What do they want in life? What values are most important to you? (Using a values card sort can be helpful here). How does this behavior fit into your value system? What ways does (the behavior) conflict with your value system ICCC/CHCTO Weekly Teleconference Calls Page 3 of 6 Eliciting Change Talk
11. Explore the pros/cons of change decisional balance Increase the discrepancy between current status and desired goal. What are the costs (not so good things) and benefits (good things) of not changing? What are the costs (not so good things) and benefits (good things) of changing? Reasons to Say the Same What are the benefits of staying the same? Reasons to Change What are your concerns about staying the same? What are your concerns about change? What are the benefits of change? 12. Use importance and confidence rulers Ask open questions about where the client sees themselves on a scale from 1 10. On a scale where one is not at all important, and ten is extremely important, how important (need) is it to you to change? Follow up: Describe why you are at a and not (lower number)? What might happen that could move you from to a [higher number]? How much you want (desire), How confident you are that you could (ability), How committed are you to (commitment). ICCC/CHCTO Weekly Teleconference Calls Page 4 of 6 Eliciting Change Talk
A Taste of Coaching Eliciting Change Talk Exercise 1. Ask for the topic Tell me about a health behavior that you are interested in changing but haven t started yet. 2. Use the following methods for evoking change talk: A. Evocative questions What concerns do you have about your current situation? What makes you think that you need to do something about this? How would you like things to be different? B. Querying extremes Suppose you continue on as you have been, without changing. What do you imagine are the worst things that might happen to you? What might be the best results you could imagine if you make the change? C. Looking forward How might your life be better if you were to make this change? Suppose you make this change. What will your life look like in five years? D. Exploring Goals and Values What are things in your life that you hold dear? What is really important to you? What are your long-term goals for yourself? How does this behavior fit in with those values or with those goals? Use your EARS! Ask for Elaboration, Tell me more Affirm the client s efforts, learnings, strengths, etc. Reflect the change talk. Summarize what you have heard with an emphasis on the change talk. 3. Ask about next steps (transition question) Where does this leave you? I wonder what you re thinking about at this point? Where does fit into your future? What s the next step? ICCC/CHCTO Weekly Teleconference Calls Page 5 of 6 Eliciting Change Talk
Importance and Confidence Rulers Ask about the issue: Tell me a little about what change you are considering. Ask about importance: How important would you say it is for you to? On a scale from 0-10, where 0 is not at all important and 10 is extremely important, where would you say you are? 0 1 2 3 4 5 6 7 8 9 10 not at all important most important Backwards question: Why did you pick a 7 and not a 0? Forwards question: What would need to happen for you to get from a 4 to an 8? Ask about confidence: Let s say you decided to make this change. How confident are you that you could do it? On the same scale from 0-10, where 0 is not at all confident and 10 is extremely confident, where would you say you are? 0 1 2 3 4 5 6 7 8 9 10 not at all confident totally confident Backwards question: Why did you pick a 4 and not a 1? Forwards question: What would need to happen for your confidence to move up a notch or two, from a 4 to a 6 or 7? Summarize Ask: Did I get it all? (Do I understand?) Ask about the next step - Where does that leave you now? - I wonder what you re thinking about at this point. - What s the next step? - Where does fit into your future? ICCC/CHCTO Weekly Teleconference Calls Page 6 of 6 Eliciting Change Talk